or mail the following registration form:
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Player’s Name:_________________________________________________ Gender: ________
Birthdate:______________ Age: :______________ Grade (2015-16): :______________
School:___________________________________________________
Parent’s Name:___________________________________________________
Home Telephone:____________________ Cell phone: ____________________
Email Address:_______________________________________________________________
Please circle which week(s) your child will be attending:
July 11-14 July 18-21 July 25-28 August 8-11
Please circle adult T-Shirt Size: S M L XL
I, (Parent or Guardian) agree, by enrolling my son/daughter that he/she is physically able to participate in all the clinic’s activities. In case of a medical emergency and I cannot be reached, I hereby give permission to the physician selected by staff to hospitalize and secure medical treatment for my child. I understand that my medical insurance is expected the cover of my child’s injuries. I agree not to hold Algonquin Regional High School/Framingham State University/Holy Name High School or the Basketball Specialists School responsible for any injury that may occur to my son/daughter while participating in the school. I also realize that the Algonquin Regional High School/Holy Name High School/ Framingham State University are not sponsoring the basketball school.
Parent/Guardian Name: __________________________ Signature ____________________
Medical Insurance: ________________________________ Policy #:___________________
Please make checks payable and mail to:
Basketball Specialists School
P.O. Box 573
Marlborough, MA 01752
